Helpful post sir. Hypothetically correct. But every one is protecting themselves with most of the contagious respiratory illnesses by wearing face mask. 2ndly chances of misconception, about of use of mask ,should not go in society which is very important at this time. Better to avoid going out of home in Lock down. Use of mask os must whenever going out. Healthcare workers should wear mask and face shield. Lastly we should learn to live with this.. Thank you sir.
Very nice post sir At places where there is no aerosolisation and well ventilated space with 3 feet distance between patient and doctor Surgical mask can be used to prevent hypoxia and hypercarbia caused by N 95 mask
Social Distance,Hand Hygiene & Immunity boosting is the only way to manage not only covid but hundreds of diseases on d way to come in future
It is very decently shown the opposite side of mask. I and many mor request to give all norms of masks for Doctor community.
Thanks break myth of mask use
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64 y/o Male w/ HTN, DM2, OSA admitted with cough, malaise and subjective fevers x 10 days. CXR on admission is posted. The second picture is hospital day 6. He had lymphopenia, normal procalcitonin and mild elevations of ferritin and d-dimer. He is COVID positive. O2 says in low 90’s on 2 L, worsened to 4-5 L NC and then improved to low 90’s on room air at rest by the time of discharge on hospital day 7. The interesting thing about this case is the discordance between his cxr findings and his symptoms/O2 requirements. I would expect worsening symptoms and O2 requirements given the cxr. He received 5 days of azithromycin and hydroxychloroquine.Dr. Shekhar Verma17 Likes20 Answers
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Care for Critically Ill Patients With COVID-19 Initial reports suggest that COVID-19 is associated with severe disease that requires intensive care in approximately 5% of proven infections. Given how common the disease is becoming, as in prior major severe acute respiratory infection outbreaks—SARS (severe acute respiratory syndrome), MERS (Middle East respiratory syndrome), avian influenza A(H7N9), and influenza A(H1N1)pdm09—critical care will be an integral component of the global response to this emerging infection. Management of severe COVID-19 is not different from management of most viral pneumonia causing respiratory failure. The principal feature of patients with severe disease is the development of ARDS: a syndrome characterized by acute onset of hypoxemic respiratory failure with bilateral infiltrates. Evidence-based treatment guidelines for ARDS should be followed, including conservative fluid strategies for patients without shock following initial resuscitation, empirical early antibiotics for suspected bacterial co-infection until a specific diagnosis is made, lung-protective ventilation, prone positioning, and consideration of extracorporeal membrane oxygenation for refractory hypoxemia. To read complete article- https://jamanetwork.com/journals/jama/fullarticle/2762996 Source- JAMA Authors- Srinivas Murthy, MD, CM, MHSc; Charles D. Gomersall, MBBS; Robert A. Fowler, MD, CM, MScDr. Vivek Jain19 Likes17 Answers
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In pathogenesis of COVID-19, hands play an important role by transporting virus from fomites mainly to nose and mouth. From mouth and nose virus spreads in the body. Saline wash of the nasal passage, mouth, and throat would probably eliminate or reduce viral load in the body mechanically at least in the initial stage of the pathogenesis. This could be similar to hand washing to contain the spread of the infection. Therefore, hypertonic saline gargles and nasal wash may work in preventing the disease and may also be useful in reducing nasopharyngeal viral load to provide symptomatic relief. Further, it may reduce viral shedding and reduce the transmission of the illness. This may break the chain of infection. COVID 19 disease is mild in eighty percent of patients and resolves spontaneously. Therefore, nasopharyngeal wash may be useful especially in subgroup of the population at high risk such as subjects with comorbid conditions and above 60 years of age. In this rapid systematic review to evaluate effect of nasopharyngeal wash majority of studies had methodological limitations. However, few studies using hypertonic saline gargles and nasal wash showed to prevent symptoms and reduce transmission, symptoms, need for symptomatic medication, and viral loads in patients of the common cold. Its utility, however, has to be studied for SARS-CoV-2 which has significant mutations from the coronaviruses that causes the common cold. Since it has been shown to work for a multitude of common viruses, logically, it should work for SARS-CoV-2 as well. The therapy could be studied as an easily available, and affordable add on modality to curb the transmission of the SARS-CoV-2. As we await definitive therapy to fight the pandemic this relative safe technique may give a ray of hope especially in prevention. COVID 19 infection starts in nasopharynx but involves lungs and other organs of the body. Therefore the effect of nasopharyngeal wash may have a limited action at nasopharynx; however, it may be more useful in prevention. The potential disadvantages of the nasal wash therapy are the discomfort in performing the procedure, however, in previous studies, it has been shown to be accepted in around 87% individuals. The second disadvantage would be the possible transmission of viral infection through the equipment used for the wash and the area where the procedure is performed. This limitation could be addressed easily by maintaining strict measures with each person use one's own equipment with no sharing amongst each other. Further, the washbasin/sink where the procedure is performed can be cleaned postprocedure. Certain precautions should be followed prior to the procedure including the use of clean water which can be ensured by boiling and subsequently cooling it. The technique of learning of nasopharyngeal wash should be supervised initially. To read more- http://www.lungindia.com/article.asp?issn=0970-2113;year=2020;volume=37;issue=3;spage=246;epage=251;aulast=SinghDr. Somesh Sharma17 Likes23 Answers
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THE COVID-19 SYMPTOMS WE DID NOT KNOW ABOUT As the pandemic spreads around the world, doctors are beginning to scope the coronavirus’s damage. Seen initially as a cause of viral pneumonia during the chaos of an explosion of cases in China, it’s now emerging as an enigmatic pathogen capable of harming the body in a myriad of unexpected, and sometimes lethal, ways. Clinical manifestations range from common cold-like symptoms and bronchitis to more severe disease such as pneumonia, severe acute respiratory distress syndrome, multi-organ failure and even death. The illness may occur as a direct result of viral infection, as well as the body’s response to it. Here’s a snapshot of some of the symptoms Covid-19 causes, including some you might not have heard about. Blood Fever and inflammation may disrupt blood vessels, rendering blood cells more prone to clumping while interfering with the body’s ability to dissolve clots. That may trigger a clotting cascade that can lead to blood-vessel blockages in tissues and organs throughout the body. Life-threatening clots in the arteries of the lung, known as pulmonary emboli, may occur even after symptoms of the infection have resolved. Damaged blood vessels may become leaky and prone to bleeding. In children, inflammation of veins and arteries triggered by excessive immune activation may cause an illness similar to Kawasaki disease, an inflammatory disorder. Brain Dysfunction in the lining of blood vessels and associated bleeding and clotting disorders may cause strokes and bleeding in the brain. Patients may also experience headache, dizziness, confusion, impaired consciousness, poor motor control, delirium and hallucinations. Eyes Red, puffy eyes, sometimes referred to as pink eye, may result from infection in the conjunctiva, the tissue that lines the inside of the eyelids and covers the white part of the eye. Gastrointestinal tract Infection of cells lining the digestive tract may cause diarrhea, nausea, vomiting and abdominal pain. Blood-vessel blockages caused by abnormal clotting have been found to damage the bowel, requiring emergency surgery and resection. Hands Prickling or burning sensation in the hands and limbs may indicate Guillain-Barré syndrome, a rare nervous-system disorder that may be triggered by aberrant immune responses to viral infection. Other symptoms of the syndrome include poor coordination, muscle weakness and temporary paralysis. Heart Cardiac injury, sometimes leading to irregular heartbeat, heart failure, and cardiac arrest, may occur as a result of excess strain, inflammation of the heart muscle and coronary artery, blood clots, and overwhelming multi-organ illness. Infection, fever, and inflammation in people with existing heart-vessel blockages may cause their fatty plaques to break off, blocking or stopping blood flow in organs and tissues. Limbs Obstructions in large blood vessels may cause insufficient flow, or acute ischemia, in the limbs. Severe vascular complications can be lethal. At least one reported cases resulted in lower limb amputation. Liver Liver dysfunction may occur as a direct result of the viral infection, or more likely because of immune-mediated, systemic inflammation and circulatory blockages cutting blood flow to the organ. Lungs The virus targets the epithelial cells that line and protect the respiratory tract as well as the walls of the tiny grape-like air sacs, or alveoli, through which gas exchange occurs to oxygenate the blood. Damage to alveoli and inflammation in the lungs can cause pneumonia, characterized by chest pain and shortness of breath. In severe cases, the lack of oxygen can trigger acute respiratory distress syndrome, leading to multi-organ-system failure. Kidneys Acute kidney injury may result from clots and impaired blood supply, or as a direct result of infection. Nose and tongue While the virus can cause the sneezing and runny nose typical of a common cold, it can also disrupt the olfactory system, causing an abrupt full or partial loss of the sense of smell known as anosmia. Taste may also become distorted in a condition known as dyguesia. Skin Hive-like rashes, small red dots and purplish discolorations on the legs and abdomen are part of a complex category of so-called paraviral dermatoses that may result from the body’s immune response to the virus or from benign, superficial blood-vessel damage beneath the skin. Toes Purple rashes that resemble chickenpox, measles or chilblains may appear on the feet, especially of children and younger adults.Dr. Prashant Ved16 Likes18 Answers
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Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women Background Previous studies on the pneumonia outbreak caused by the 2019 novel coronavirus disease (COVID-19) were based on information from the general population. Limited data are available for pregnant women with COVID-19 pneumonia. This study aimed to evaluate the clinical characteristics of COVID-19 in pregnancy and the intrauterine vertical transmission potential of COVID-19 infection. Methods Clinical records, laboratory results, and chest CT scans were retrospectively reviewed for nine pregnant women with laboratory-confirmed COVID-19 pneumonia (ie, with maternal throat swab samples that were positive for severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) who were admitted to Zhongnan Hospital of Wuhan University, Wuhan, China, from Jan 20 to Jan 31, 2020. Evidence of intrauterine vertical transmission was assessed by testing for the presence of SARS-CoV-2 in amniotic fluid, cord blood, and neonatal throat swab samples. Breastmilk samples were also collected and tested from patients after the first lactation. Findings All nine patients had a caesarean section in their third trimester. Seven patients presented with a fever. Other symptoms, including cough (in four of nine patients), myalgia (in three), sore throat (in two), and malaise (in two), were also observed. Fetal distress was monitored in two cases. Five of nine patients had lymphopenia (<1·0 × 10⁹ cells per L). Three patients had increased aminotransferase concentrations. None of the patients developed severe COVID-19 pneumonia or died, as of Feb 4, 2020. Nine livebirths were recorded. No neonatal asphyxia was observed in newborn babies. All nine livebirths had a 1-min Apgar score of 8–9 and a 5-min Apgar score of 9–10. Amniotic fluid, cord blood, neonatal throat swab, and breastmilk samples from six patients were tested for SARS-CoV-2, and all samples tested negative for the virus. Interpretation The clinical characteristics of COVID-19 pneumonia in pregnant women were similar to those reported for non-pregnant adult patients who developed COVID-19 pneumonia. Findings from this small group of cases suggest that there is currently no evidence for intrauterine infection caused by vertical transmission in women who develop COVID-19 pneumonia in late pregnancy. To read more- https://www.sciencedirect.com/science/article/pii/S0140673620303603 Source-sciencedirectDr. Pushker Mehra10 Likes15 Answers